Risk Factors for Falls in Tertiary Hospital Inpatients: A Survival Analysis

상급종합병원 입원환자의 낙상 위험요인: 생존분석으로

  • Cho, Young Shin (Surgical Intensive Care Unit, Kosin University Gospel Hospital) ;
  • Lee, Young Ock (Surgical Intensive Care Unit, Kosin University Gospel Hospital) ;
  • Youn, Young Sun (Diabetic Practice Classroom, Kosin University Gospel Hospital)
  • 조영신 (고신대학교복음병원 외과계중환자실) ;
  • 이영옥 (고신대학교복음병원 외과계중환자실) ;
  • 윤영순 (고신대학교복음병원 당뇨교실)
  • Received : 2018.10.19
  • Accepted : 2018.12.03
  • Published : 2019.02.28

Abstract

Purpose : The purpose of this study was to identify the risk factors for falls in tertiary hospital inpatients and to suggest data for developing a nursing intervention program for preventing falls. Methods: Data were collected between January 1, 2017, to December 31, 2017. Kaplan-Meier estimation was used to measure the survival rate, and the log-rank test was used for the differences between the fall group and the non-fall group. The Cox proportional hazards model was used to identify the risk factors for falls. Results: The incidence rate of falls for the inpatients was 1.2 cases per 1,000 days of hospitalization. The risk factors for falls were more likely to be found among those who were aged ${\geq}81$, had not undergone surgery, had poor joint motion, had unsteady gait, needed help or supervision, used assistive devices, had comorbidity, and took at least two drugs. Conclusion: For the inpatients, the risk factors for falls included age, surgery, comorbidity, medication that could change mobility, joint motion, and use of patient care equipment. It is necessary to give special attention to inpatients who have any of these risk factors and to develop a falls risk assessment tool.

Keywords

References

  1. Bae, J. M. (2012). An illustrated guide to medical statistics using SPSS. Seoul: Hannare.
  2. Choi, E. H., Ko, M. S., Yoo, C. S., & Kim, M. K. (2017). Characteristics of fall events and fall risk factors among inpatients in general hospitals in Korea. Journal of Korean Clinical Nursing Research, 23(3), 350-360. https://doi.org/10.22650/JKCNR.2017.23.3.350
  3. Choi, E. J., Lee, Y. S., Yang, E. J., Kim, J. H., Kim, Y. H., & Park, H. A. (2017). Characteristics and risk factors for falls in tertiary hospital inpatients. Journal of Korean Academy of Nursing. 47(3), 420-430. https://doi.org/10.4040/jkan.2017.47.3.420
  4. Cox, J., Thomas-Hawkins, C., Pajarillo, E., DeGennaro, S., Cadmus, E., & Martinez, M. (2015). Factors associated with falls in hospitalized adult patients. Applied Nursing Research, 28(2), 78-82. https://doi.org/10.1016/j.apnr.2014.12.003
  5. Evans, D., Hodgkinson, B., Lambert, L., & Wood, J. (2001). Falls risk factors in the hospital setting: A systematic review. International journal of nursing practice, 7(1), 38-45. https://doi.org/10.1046/j.1440-172x.2001.00269.x
  6. Gringauz, I., Shemesh, Y., Dagan, A., Israelov, I., Feldman, D., Pelz-Sinvani, N., . . . Segal, G. (2017). Risk of falling among hospitalized patients with high modified Morse scores could be further stratified. BMC health services research, 17(1), 721. https://doi.org/10.1186/s12913-017-2685-2
  7. Hendrich, A. L., Bender, P. S., & Nyhuis, A. (2003). Validation of the Hendrich II fall risk model: A large concurrent case/control study of hospitalized patients. Applied Nursing Research, 16(1), 9-21. https://doi.org/10.1053/apnr.2003.016009
  8. Jang, I. S., & Lee, S. G. (2014). Fall risk factors and characteristics of an acute hospital setting across clinical departments. Journal of the Korean Academy of Fundamentals of Nursing, 21(3), 264-274. https://doi.org/10.7739/jkafn.2014.21.3.264
  9. Kang, Y. O., & Song, R. (2015). Identifying characteristics of fall episodes and fall-related risks of hospitalized patients. Journal muscle Joint Health, 22(3), 149-159. https://doi.org/10.5953/JMJH.2015.22.3.149
  10. Kim, C. G., & Suh, M. J. (2002). An analysis of fall incidence rate and its related factors of fall in inpatients. Journal of Korean Society of Quality Assurance in Health Care, 9(2), 210-228.
  11. Kim, E. K., Lee, J. C., & Eom, M. R. (2008). Falls risk factors of inpatients. Journal of Korean Academy of Nursing, 38(5), 676-684. https://doi.org/10.4040/jkan.2008.38.5.676
  12. Kim, K. S., Kim, J. A., Choi, Y. K., Kim, Y. J., Park, M. H., Kim, H. Y., & Song, M. S. (2011). A comparative study on the validity of fall risk assessment scales in Korean hospitals. Asian Nursing Research, 5(1), 28-37. https://doi.org/10.1016/S1976-1317(11)60011-X
  13. Kim, Y. S., & Choi-Kwon, S. (2013). Fall risk factors and fall risk assessment of inpatients. Korean Journal of Adult Nursing, 25(1), 74-82. https://doi.org/10.7475/kjan.2013.25.1.74
  14. Lee, J. E., & Stokic, D. S. (2008). Risk factors for falls during inpatient rehabilitation. American journal of physical medicine & rehabilitation, 87(5), 341-353. https://doi.org/10.1097/PHM.0b013e31816ddc01
  15. Morse, J. M. (2009). Preventing patient falls: Establishing a fall intervention program (2nd ed.). New York, NY: Springer Publishing Company.
  16. Morse, J. M., Morse, R. M., & Tylko, S. J. (1989). Development of a scale to identify the fall-prone patient. Canadian Journal on Aging, 8(4), 366-377. https://doi.org/10.1017/S0714980800008576
  17. National Patient Safety Agency. (2007). Slips, trips and falls in hospital. Retrieved October 5, 2017, from http://www.nrls.npsa.nhs.uk/resources/?entryid45=59821
  18. Needham, D. M., Davidson, J., Cohen, H., Hopkins, R. O., Weinert, C., Wunsch, H., . . . Brady, S. L. (2012). Improving long-term outcomes after discharge from intensive care unit: Report from a Stakeholders' conference. Critical care medicine, 40(2), 502-509. https://doi.org/10.1097/CCM.0b013e318232da75
  19. Nunan, S., Brown Wilson, C., Henwood, T., & Parker, D. (2018). Fall risk assessment tools for use among older adults in long-term care settings: A systematic review of the literature. Australasian journal on ageing, 37(1), 23-33. https://doi.org/10.1111/ajag.12476
  20. Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clinics in geriatric medicine, 26(4), 645-692. https://doi.org/10.1016/j.cger.2010.06.005
  21. Poe, S. S., Cvach, M., Dawson, P. B., Straus, H., & Hill, E. E. (2007). The Johns Hopkins fall risk assessment tool: Postimplementation evaluation. Journal of nursing care quality, 22(4), 293-298. https://doi.org/10.1097/01.NCQ.0000290408.74027.39
  22. Poe, S. S., Cvach, M. M., Gartrell, D. G., Radzik, B. R., & Joy, T. L. (2005). An evidence-based approach to fall risk assessment, prevention, and management: Lessons learned. Journal of Nursing Care Quality, 20(2), 107-116. https://doi.org/10.1097/00001786-200504000-00004
  23. Severo, I. M., Almeida, M. D. A., Kuchenbecker, R., Vieira, D. F. V. B., Weschenfelder, M. E., Pinto, L. R. C., . . . Panato, B. P. (2014). Risk factors for falls in hospitalized adult patients: An integrative review. Revista da Escola de Enfermagem da USP, 48(3), 540-554. https://doi.org/10.1590/S0080-623420140000300021